Provider Demographics
NPI:1700981909
Name:MANGHERA, MICHAEL A (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MANGHERA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W BULLARD AVE STE F2
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-7611
Mailing Address - Country:US
Mailing Address - Phone:559-240-1489
Mailing Address - Fax:
Practice Address - Street 1:200 W BULLARD AVE
Practice Address - Street 2:SUITE F2
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612
Practice Address - Country:US
Practice Address - Phone:559-298-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 178331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical